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The Social Security Disability Benefits Claim Process
When you apply for Social Security Disability benefits, you are required to prove to the Social Security Administration that your disability is serious enough to qualify. The Social Security Administration has established a five-step evaluation process for determining whether an individual is disabled.
Step 1: Are you working? –Social Security must first determine whether you are engaging in substantial gainful activity (SGA). If you are engaging in work activity that is both substantial and gainful, Social Security will not find you disabled regardless of how severe your physical or mental impairments are. If you are not engaging in SGA, the evaluation proceeds to the second step.
Step 2: Do you have a severe medical impairment? – At step two, Social Security must determine whether you have a “severe” medical impairment. A medical impairment is “severe” if it significantly limits your ability to perform basic work activities. A medical impairment that has no more than a minimal effect on your ability to work is “not severe”. If you are determined to have a “severe” impairment, the evaluation proceeds to the third step.
Step 3: Does your medical impairment meet a listing? – At step three, Social Security will determine whether your medical impairment is of a severity to meet the criteria of an impairment listed in 20 CFR Part 404. If your medical impairment is severe enough to meet the criteria of a listing, you will be determined disabled. If not, the evaluation proceeds to step four.
Step 4: Can you perform past work? – Step four requires Social Security to determine whether you have the functional capacity to perform the requirements of your past relevant work. If you have the functional capacity to do your past relevant work, you are not disabled. If you are unable to do any past relevant work (or do not have any past relevant work), the evaluation proceeds to the last step.
Step 5: Can you do any other work? – At step five, Social Security must determine whether you are able to do any other work considering your functional capacity, age, education and work experience. If you are able to do other work, you are not disabled. If you are unable to do other work, you will be found disabled.
Medical Impairments that Can Qualify You for Social Security Disability
As mentioned above in “step three”, there are a significant number of medical impairments that can qualify you for Social Security Disability benefits if it is determined that your medical impairment is of a severity to meet the criteria of an impairment listed in 20 CFR Part 404. This list of medical impairments is often referred to as the “Blue Book.” Social Security will review all of your medical records to determine if your medical impairments “meet a listing.” Some of the more common medical impairments found in the “Blue Book” are listed below:
- Vision or hearing loss
- Cystic fibrosis
- Chronic heart failure
- Coronary artery disease
- Cirrhosis of the liver
- Inflammatory bowel disease
- Hemophilia or blood disorder
- Multiple sclerosis
- View the entire listing here.
I Qualified for SSD Benefits — Now What?
Since the application and approval process for SSD benefits can take a long time, you will likely be relieved when you qualify for benefits. Once you are qualified for SSD benefits, you will be paid in monthly installments. For SSDI benefits, the amount you receive is based on your average lifetime earnings before you were disabled, not on how much income you have or your disability. SSI benefits are capped at no more than $750.00 per month, but can be further reduced depending on your financial situation.
What If Your Medical Impairment Is Not Listed?
You may still qualify for SSD benefits even if you don’t “meet a listing” or your medical impairment is not listed in the “Blue Book”. In order to qualify, however, you will need produce evidence that your disability limits your residual functional capacity (RFC). An individual’s RFC is his ability to do physical and mental work activities on a sustained basis despite limitations from his or her impairments.
Medical evidence needed to prove your disability may include, but is not limited to:
- Physical exams
- MRI, CAT scan reports
- Mental health records
- Blood work results
- Emergency room report
What If My SSD Claim Is Denied?
If your SSD claim is denied, it is important that you speak to an experienced Social Security Disability attorney. At Rainwater, Holt & Sexton, our attorneys know how difficult and lengthy the appeals process can be. We also know that you need money now. We fight aggressively for our disability clients, to help them obtain the benefits they are entitled to receive. In order to build the best case for you, it is important to understand why your SSD claim may have been denied. Some of the most common reasons for denial include:
- Too much earned income – You may not be working as much as you would like, but if you are making more than the substantial gainful activity (SGA) limit, you will be denied benefits. Part-time work is sometimes allowed, but if you are making $1,180.00 per month (the SGA limit in 2018 for non-blind individuals) you will be denied.
- Disability isn’t severe enough – If it is determined that your medical impairments are not severe enough, or expected to improve within twelve (12) months, your claim will be denied. Your attorney can review your medical evidence to determine if additional medical testing or medical treatment is necessary to support your claim.
- Failure to follow prescribed therapy – If you are being treated by a doctor, but you fail to follow the prescribed therapy to improve your medical impairment, then you could be denied SSD benefits. There are some acceptable medical excuses the SSA will allow, such as mental illness or physical limitations. Financial hardships and religious beliefs may also be acceptable excuses.
- Disability is based on drug or alcohol abuse – If your alcoholism or drug addiction is a contributing factor to your disability and inability to work, then you may be denied SSD benefits.
Factors That Could Affect Your SSD Benefits
There are numerous factors that may affect your SSD benefits and the amount you would receive. Some of those factors include:
- Turning 18 – If you were receiving SSI benefits as a child, turning 18 could put those benefits in jeopardy. Your impairments will be reevaluated as an adult before being able to collect SSI as an adult.
- Reaching retirement age – Once you reach retirement, your SSD benefits will be transferred to the retirement benefit program.
- Improved medical condition – If the medical condition for which you were receiving disability benefits improves, you may lose your ability to collect SSD.
- Returning to work – If you return to work while you are receiving SSD, then you could raise your SGA and no longer be eligible for SSD.
- Marital status – If you remarry or get married while receiving SSI benefits, your spouse’s income could change the level of your payments.
- Crime conviction – If you have been convicted of a crime, you may lose your ability to collect SSI or SSDI.
What If My Child Is Disabled?
If your child is disabled, they will be eligible to receive Social Security Income until they are 18 years old. To become eligible for SSI, you must clearly establish your child’s impairment results in severe and functional limitations and can be expected to last for at least 12 months. The Social Security Administration has a separate “Blue Book” of impairments and conditions that would qualify for benefits. Once your child turns 18, their impairments will be evaluated based on the definition of disability for adults.
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Why Hire a Lawyer?
The SSD benefits process is long and oftentimes complex. Hiring an experienced SSD attorney to represent you through this process is important because the vast majority of SSD claims are denied at the initial claim level. Most SSDI and SSI claims will need to go to a hearing before benefits will be received. Having an SSD attorney on your side can help you win your claim and begin collecting the benefits to which you are entitled. Your attorney will ensure that all medical evidence is presented clearly and that your case is properly developed prior to your hearing. They know what questions to ask your doctor and what medical tests the judge will likely need to see before making their determination. With so much is at stake, it’s important to call the Arkansas SSD attorneys at Rainwater, Holt & Sexton.
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Arkansas is our home and we want to make sure our neighbors and friends are supported. With four offices in Arkansas—Little Rock, Fayetteville, Conway, and Hot Springs—our Arkansas Social Security Disability lawyers are easily accessible when you need help.
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Rainwater, Holt & Sexton Injury Law Blog
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